Percutaneous Coronary Intervention Is Not Superior to Optimal Medical Therapy in Chronic Coronary Syndrome: A Meta-Analysis

Area of Science:

• Cardiology
• Interventional Cardiology
• Clinical Trials

Background:

• Conflicting evidence exists on the benefits of percutaneous coronary intervention (PCI) versus optimal medical therapy (OMT) for chronic coronary syndrome (CCS).
• Evaluating the comparative effectiveness of PCI and OMT on survival and symptom relief in CCS is crucial.

Purpose of the Study:

• To conduct a meta-analysis evaluating the short- and long-term clinical benefits of PCI compared to OMT in patients with CCS.
• To assess the impact of PCI on major adverse cardiac events, mortality, myocardial infarction, revascularization, stroke, and quality of life.

Main Methods:

• Meta-analysis of fifteen randomized controlled trials (RCTs) involving 16,443 patients with CCS.
• Endpoints included major adverse cardiac events (MACEs), all-cause mortality, cardiovascular (CV) mortality, myocardial infarction (MI), urgent revascularization, stroke, and quality of life (QoL).
• Evaluated clinical endpoints at very short (≤3 months), short- (<12 months), and long-term (≥ 12 months) follow-up.

Main Results:

• At a mean follow-up of 27.7 months, PCI showed similar risks of MACE, all-cause mortality, CV mortality, and MI compared to OMT.
• No significant differences were observed in stroke or hospitalizations for anginal symptoms between PCI and OMT groups.
• PCI patients experienced improved QoL in the very short-term, but these benefits diminished by long-term follow-up.

Conclusions:

• Percutaneous coronary intervention (PCI) does not provide significant long-term clinical benefit compared to optimal medical therapy (OMT) for patients with chronic coronary syndrome (CCS).
• The findings suggest a need for careful patient selection for PCI, emphasizing that it does not improve long-term survival or reduce major adverse cardiac events.
• While PCI may offer short-term quality of life improvements, these are not sustained, reinforcing the primary role of OMT in CCS management.